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General NPI Number Information
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NPI Number | 1699961219
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Entity Type | Organization
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Legal Business Name | STAR VISION CORPORATION LTD
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 4132 N HARLEM AVE STE A
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City | NORRIDGE
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State | IL
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Zip | 60706-1270
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Country | US
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Telephone | 708-456-2271
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Fax | 708-456-2297
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Provider Business Mailing Address
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Address Line | 4132 N HARLEM AVE STE A
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City | NORRIDGE
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State | IL
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Zip | 60706-1270
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Country | US
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Telephone | 708-456-2271
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Fax | 708-456-2297
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JOHN JOSEPH STERCZEK
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Credential | OD
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Telephone | 708-456-2271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046007944
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License Number State | IL
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